Prevalence and predictive factors for posterior vitreous attachment in eyes undergoing epiretinal membrane surgery

To develop a consensus nomenclature for the classification of retinal and choroidal layers and bands visible on spectral-domain optical coherence tomography (SD-OCT) images of a normal eye.

To determine the prevalence and factors associated with epiretinal membranes in a random sample of the population aged 40 years and older in Victoria, Australia. Population-based cross-sectional study. Detailed eye examinations, including retinal photographs, were conducted in 1992 and 1997 in 3271 people (83% of the eligible) in Melbourne and 1473 (92% of the eligible) in rural Victoria. Eyes present with either cellophane macular reflex (CMR) or preretinal macular fibrosis (PMF) were classified as having epiretinal membranes. Eyes with both CMR and PMF present were classified as having PMF. Age-standardized prevalence rates and 95% confidence limits were calculated by the direct methods using Segi's world population. Epiretinal membranes were observed in 253 of 4313 participants (6.0%; 95% confidence interval [CI] 5.2 to 6.7), bilaterally in 19%. Prevalence increased significantly by age group (0.5% for 40 to 49 years, 2.6% for 50 to 59 years, 9.4% for 60 to 69 years, 15.1% for 70 to 79 years, and 11.3% for 80 years and older). Prevalence was similar in males and females after adjusting for age. The overall age- and gender-standardized prevalence of CMR was 4.8% (95% CI 4.0 to 5.6) and PMF was 1.7% (95% CI 1.2 to 2.3). A decrease in visual acuity (<6/6) was significantly associated with idiopathic PMF (odds ratio [OR] 1.9; 95% CI 1.0 to 3.6) and CMR (OR 1.5; 95% CI 1.1 to 2.0) after adjusting for age. The prevalence of epiretinal membranes was similar to that reported in other population-based studies. Population shifts in the age distribution to older ages could lead to an increase in mild visual impairment caused by epiretinal membranes.

To investigate the relationship between the presence of the photoreceptor inner and outer segment (IS/OS) junction and visual acuity after epiretinal membrane (ERM) surgery. Seventy eyes of 70 consecutive patients who had undergone vitrectomy for idiopathic ERM were examined by optical coherence tomography before and 3 and 6 months after surgery. The IS/OS junction was graded into three grades. The time course of recovery of the IS/OS junction, central foveal thickness (CFT) and best corrected visual acuity (BCVA) during the postoperative period was studied. A normal IS/OS junction was detected in 47.1% of the eyes before surgery and in 65.7% at 3 months and 75.7% at 6 months after. There was a significant correlation between the IS/OS grade and BCVA before and at 3 and 6 months after the operation (p = 0.0001, p<0.0001, p<0.0001, respectively). The preoperative IS/OS junction grade correlated significantly with BCVA at 6 months (p = 0.0239). CFT did not correlate significantly with BCVA at 3 and 6 months. The presence of a normal IS/OS junction was associated with good visual acuity after ERM surgery. A normal IS/OS junction probably indicates morphological and functional recovery of the photoreceptors.